Measure Me, My Group, or the Hospital?

CMS is overseeing a physician initiative in four states, and you likely know little about it.  Additionally, you are probably unaware of the program it seeks to inform.

In 2015, Medicare will begin to assess physician performance on cost and quality data.  Through a value-based code, our newly adjusted fees will reflect these measurements, relative to our peers—with the intent of raising the care delivery bar at the doctor level.  The public will have also access to this information.

Here is the very concise, one page primer on the program.  Some physicians in Kansas, Iowa, Missouri, and Nebraska now receive these report cards.

One issue for hospitalists, and other hospital-based groups (ER, ICU, radiology), is the correct level of analysis and the tradeoffs involving each option.  Choosing valid process or outcome measures is a topic for another day.

Nothing is certain, and professional societies like SHM have an opportunity to inform CMS on the approach that works best.  Selecting wisely will ensure we balance public and HM interests, understanding compromise is necessary.

The following is my take on the options:

The issues of risk adjustment, episode grouping, data turnaround (2015 compensation reflects 2013 practice), correct physician attribution, etc., are unsolved and controversial.  Above is only step one, but a big one.  Most hospital-based practitioners will prefer a group analysis, but CMS will nudge (longer-term) towards the hospital slant given its goal of cultivating population health.

What is your opinion?

PS–Here is a good 5-minute video on the VBP program from Kaiser Health News.  Worth it!  Also, the Washington Post story from the same reporter (Jordan Rau, who is top-notch btw, and works the inpatient beat).

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

2 Comments

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